Government would pay seniors to create advanced directives under Senate bill

Medicare beneficiaries would be paid to create advance directives and store them in an easy-access system if a recently proposed Senate bill were to become law.

The “Medicare Choices Empowerment and Protection Act” was introduced Friday by Sen. Tom Coburn, M.D. (R-OK). It would pay eligible beneficiaries $75 for creating an online advance directive or $50 for creating one manually in 2015, with incentives in subsequent years tied to consumer price inflation.

It also calls for an accreditation process to be established for advance directive vendors participating in the program, and the creation of a system to facilitate easy access to advance directives for beneficiaries, suppliers, providers and healthcare proxies. Registration of the directives would occur during a beneficiary's initial enrollment in Medicare Part C, commonly known as Medicare Advantage.

The bill says that the Centers for Medicare & Medicaid Services should consult with experts when establishing and implementing the program, including nurses, palliative care experts and health information privacy authorities.

Advance directives generally are seen as instrumental in guiding healthcare for those who lose the ability to communicate their wishes, including long-term care residents with advanced dementia. Recent studies have indicated that directives might be enhanced by including more information about preferred treatment settings and “gray area” issues, such as providing antibiotics to terminal patients.

Drug substitutions saved the government $13 million last year, but more drug substitutions under Medicare Part B would have saved an additional $6 million, the Office of Inspector General for Health and Human Services concluded in a recent report to Congress.